Chapter 11 -- Eating Disorders

I. Eating Disorders

A. Anorexia Nervosa
1. Restriction of behaviors that promote healthy weight; Body Mass Index less than 18.5 for adults
2. Intense fear of gaining weight
3. Distorted body image
B. Characteristics
1. Less than 1% prevalence (90% female)
2. 20% attempt suicide, 5% complete it
C. Physical Changes
1. Low blood pressure, heart rate decrease
2. Kidney and gastrointestinal problems
3. Loss of bone mass
4. Brittle nails, dry skin, hair loss
5. Lanugo - soft, downy body hair
6. Depletion of potassium and sodium electrolytes can cause tiredness, weakness, and death
D. Prognosis
1. 50-70% eventually recover (often takes 6 or 7 years and relapse is common)
2. Difficult to modify distorted view of self, especially in cultures that highly value thinness
3. Anorexia is life threatening
a. Death rates 10 times higher than general population
b. Death rates 2 times higher than other psychological disorders

II. Bulimia Nervosa

A. Diagnostic Symptoms
1. Recurrent episodes of binge eating; excessive food consumed in under 2 hours; loss of control over eating
2. Recurrent compensatory behaviors to prevent weight gain (fasting, vomiting, excessive exercise, laxatives, diuretics)
3. Body shape and weight are extremely important for self-evaluation
4. A minimum of one binge eating episode a week for 3 months
B. Characteristics
1. 1 to 2% prevalence
2. Eating binges triggered by negative emotions or negative social interactions
3. Typical food choices of cookies, cake, pasta, ice cream
4. Avoiding craved food increases chance of binge
5. Typically binge and purge in secret
6. Shame and remorse are common
C. Physical Changes
1. Menstrual irregularities
2. Depletion of potassium and sodium electrolytes can cause cardiac irregularities and death
3. Loss of dental enamel from stomach acids in vomit
4. Mortality rate of 4%
D. Prognosis
1. Approximately 75% recover
2. 10 - 20% remain fully symptomatic
3. Early intervention has better outcomes
4. Poorer prognosis when depression and substance abuse are comorbid

III. Binge Eating Disorder

A. Diagnostic Symptoms
1. Recurrent episodes of binge eating; on average at least once a week
2. Binge episodes have 3 of the following:
a. eat more rapidly than normal
b. eat until uncomfortably full
c. eat large amounts when not hungry
d. eat alone due to embarrassment
e. feeling disgusted, guilty, or depressed after the binge
3. No compensatory behavior is present
B. Characteristics
1.Approximately 2-25% of obese may qualify
2. Body Mass Index more than 30
3. Equally prevalent among Euro-, African-, Asian-, and Hispanic-Americans
4. Risk factors include childhood obesity, early childhood weight loss attempts, teasing about weight, low self-concept, childhood abuse
C. Physical Changes
1. Increased risk of Type II Diabetes
2. Increased cardiovascular disease
3. Breathing problems
4. Joint and muscle pain
D. Prognosis
1. Approximately 60% recover
2. Lasts on average 14.4 years

IV. Etiology of Eating Disorders

A. Biological Factors
1. Genetics (Children of parents with eating disorders are 4 times as likely, 50% contribution)
2. Low levels of endogenous opioids (beta-endorphins) that reduce pain, enhance mood, and suppress appetite
3. Opioids released during starvation and excessive exercise
4. Low levels of serotonin prevent feeling full
B. Psychological Factors
1. Body dissatisfaction and perfectionism
2. Increased dieting
3. Anxiety and depression
4. Lack of positive and stable relationships
C. Sociocultural Factors
1. Thin-ideal internalization, especially for women
2. Unrealistic media portrayals
3. More sedentary lifestyle leads to overweight
4. Rigid families with poor communication, conflict, and less support

V. Treatment

A. Treatment for Anorexia
1. Hospitalization to monitor eating
2. Cognitive-behavioral therapy
3. Family-Based Therapy with family lunch sessions
B. Treatment for Bulimia
1. Self-Monitoring of eating behavior
2. Education on proper nutrition
3. Reinforcement of healthy eating
4. Cognitive restructuring
5. Improve self-esteem and relationships
6. Antidepressants
C. Treatment for Binge Eating Disorder
1. Cognitive-behavioral therapy
2. Self-Monitoring of eating behavior
3. Education on proper nutrition
4. Reinforcement of healthy eating
5. Cognitive restructuring
6. Interpersonal Therapy to improve relationships and increase social support

VI. Prevention

A.Psychoeducational Approaches educate about the dangers of eating disorders
B. Reduce Sociocultural Influences: dissonance reduction intervention to counter social and cultural pressures
C. Risk Factor Approach – healthy eating and exercise programs